Apophyseal avulsion fractures of the pelvis are injuries that typically occur in adolescent athletes [
1]. At this age the secondary ossification at the apophyses coincides with the hormonally induced strengthening of the muscles [
2]. Sudden large tension forces can be applied through the musculotendinous units due to forceful concentric muscle contraction or passive lengthening of the muscle especially during sporting activities. Because the cartilaginous growth plates at the apophyses of the adolescents are more prone to trauma than the musculotendinous units, they may fail resulting in a avulsion fracture of the pelvis [
3]. Patients usually report a crack in the pelvic region during an activity with a sudden onset of pain [
4,
5]. The pain is more severe during activity and decreases with rest. Clinical examination reveals local tenderness, limitation of motion, and swelling [
6,
7]. The apophyses may fracture at the rectus femoris insertion at the anterior inferior iliac spine (AIIS), the hamstrings insertion at the ischial tuberosity (IT), the sartorius insertion at the anterior superior iliac spine (ASIS), the tensor fasciae latae insertion on the iliac crest (IC), the iliopsoas insertion on the lesser trochanter (LT), or the rectus abdominis insertion at the superior corner of the pubic symphysis (SCPS) [
8‐
10]. Historically, most of the pelvic avulsion fractures have been treated nonoperatively including analgetics, bed rest, immobilization of the affected muscle group, and physical rehabilitation [
11]. However, controversy persists which fractures and patients may benefit from operative treatment [
5,
12]. The Grade of fracture displacement and the physical demands of the athlete can be important factors in the decision process for or against surgery [
5,
11]. Long-term and sport-specific outcomes of these fractures have not been well studied and there is little data on the incidence of complications like non-union, heterotrophic ossifications, neurological sequelae, wound infections, persistent pain or functional restrictions. The available evidence appears unsatisfactory. The purpose of this systematic review with meta-analysis was to assess and summarize the patient demographics, epidemiology, mechanism of injury, clinical outcome, and return to sports to give support in the decision-making process regarding therapy in adolescent patients with avulsion fractures of the pelvis.